A day in the life of a Neonatal Psychological Professional
My role
As a child psychotherapist on a NICU I am part of a large multi-disciplinary team where I provide an important reflective and containing contribution for babies, parents and staff. I attend to the baby’s psychological and emotional development as they start to build a relationship and an attachment with their parents. There are often impingements on this development especially where there have been traumatic beginnings. Despite babies being in incubators parents can be supported to provide for their baby in a very different way to the way they had anticipated. It is a well-established principal within the psychoanalytic tradition that when unbearable feelings are put into words they can be thought about, reflected upon and can lose their toxicity. Staff manage a range of emotions when a newborn baby’s fragile world teeters on the edge between life and death. Formal and informal staff consultation can provide some containment to staff where feelings of distress and anxiety can be thought about and understood.
A typical day
There are no two days the same though a theme throughout every day is how I am called upon to bear witness, standing alongside others, particularly parents, during this emotionally fraught period where feelings of anger, blame, helplessness, loss and grief dominate.
I arrive early in the morning often when there are no parents present. There is an air of anticipation for the day ahead. The unit is never quiet with alarms constantly bleeping alongside indistinguishable conversations. The unit begins each day with a feeling of starting clean, fresh and new. I attend the 09.00 morning hand-over where each baby is discussed particularly those who have deteriorated or improved. It is not always possible to plan what is required each day as uncertainty over-shadows events. Parents begin to arrive on the unit. Some parents I will already know though other parents arrive minutes or hours after the birth of their baby sore, sleep deprived and anxious. I introduce myself to parents tailoring what I say to what I already know about their journey so far. I will give a few brief accounts of some of my psychotherapeutic work. For reasons of confidentiality names have been changed and accounts of the work have been amalgamated.
I sit beside the incubator with Rebecca, a single mum whose daughter, Sophie was born at 23 weeks and 4 days gestation. Sophie is now 3 weeks old. Rebecca expresses her need to hold Sophie in her arms. She tells me she does not know what Sophie smells like yet. I suggest that there may be other ways to hold Sophie, not physically but psychologically. I think with Rebecca about her preoccupation of Sophie, of her being constantly in Rebecca’s mind. This preoccupation is extremely valuable at the beginning of every baby’s life. Rebecca has her hand touching Sophie’s hand stroking her fingers. She talks about her parents, how supportive they are and about her best-friend cooking food for her. These relationships support, hold and nourish Rebecca.
I introduce myself to parents Cynthia and Benny who gave birth to twin boys 6 hours ago, 6 weeks earlier than planned. Both babies experienced respiratory distress after birth. Cynthia sits beside one of her son’s incubators and says she does not know where to be as she has two babies to sit beside. Benny and I stand and together I invite them to share what happened which they do. Cynthia cries when I ask her about names for her sons. Benny says they have not yet been able to fully see what they look like so want to see if they suit the names they previously thought about.
I attend a weekly psychosocial team meeting. I provide a mental health and a psychoanalytic perspective within this team discussion. Modelling and encouraging reflective practice are important specialist interventions I bring as a child psychotherapist within these discussions. This includes an awareness of personal responses to particular encounters with babies and their families. When decisions are being reached by families and the team to redirect care towards the end of life, these discussions can be emotionally containing for staff at times of high anxiety and stress.
I usually take my lunch break in the staff room. This helps with feeling part of the team. There are sometimes conversations about food, TV shows or films, planned holidays and pregnancies or babies born to staff members.
After lunch I spend some time with parents I have worked with for several months. Adelola and Conrad have twins, Ronke and Ige who are now 12 weeks old and are tomorrow being discharged home. Adelola is rooming in with her babies getting help to transition to life outside the hospital. Uncertainty about their futures remain with Ige requiring further care and support from a team of community nurses. Both parents have been helped to start a narrative for their children about their first few months of life. They have photographs which chart both the happy and sad times they have experienced. I suggest starting with a few words for Ronke and Ige which are age appropriate and can be added to over time about their NICU experience. We say our final goodbyes and I wish them all well for the future.
I meet with Louise, the Family Care Co-ordinator for NICU providing weekly clinical supervision in support of her role and development. She brings several aspects of her clinical work which we think about together.
I spend some time sitting alone beside the cot observing baby Marta. Marta is now 18 days old with concerns about her long-term neurological state due to being exposed to illicit drugs in pregnancy. Children’s social care work closely with the staff to make safe provision for Marta. She twitches and her body is never still. Marta’s irritability seems to permeate into others around her. There is often an attempt to sooth Marta though a nurse tells me that nothing they do seems to help. I speak about the difficulties of staying still and quiet when with Marta and how perhaps this might be what she needs at times.
The moment I will always remember
I have enormous respect for my colleagues which includes the whole team from administration reception staff, the cleaners, the nursing team and junior and senior doctors. When an emergency buzzer was pulled colleagues knew what each person needed to do to save the life of a very sick baby. Perhaps I was the only one not busy with doing but standing beside parents, being with them, watching and being emotionally present with them as their baby deteriorated.
What I love about what I do
I feel immensely honoured and privileged to be working as a child psychotherapist on a NICU. Parents and staff have allowed me to be alongside them at times when they are managing a whole range of emotions. I feel such gratitude towards the parents I work with as they share with me such raw and unprocessed emotions at such a traumatic time in their lives. This feeling of gratitude extends to my colleagues who I respect and appreciate. Parents and staff openly express their gratitude for my contribution. By being interested in the internal world of others, of attending to their thoughts and feelings, can promote interest and awareness of their own internal world.
One thing I wish I had known when I started out
Saying goodbye is particularly challenging. There are many goodbyes. No-one knows what tomorrow will bring. I feel particularly aware of some of the uncertainty parents and staff experience when they say goodbye at the end of the day or shift. Babies can deteriorate and improve quickly. Some babies move to other units for more specialised input. Others move to units closer to home.
Despite these babies having had a traumatic beginning at the start of their life the unit is a nurturing, fun-loving, often joyous place where at times laughter and singing are heard above the machine alarms. Most babies go home with their families. We always wonder what life is like for them beyond their NICU experience. Some parents send photos, updates and come back and visit with their growing families.
References
ACP Position Statement (March 2023) The Role and Contribution of Child and Adolescent Psychotherapists in the Neonatal Unit
